Articles Tagged with Kickbacks

big-pharma-300x196Jazz Pharma, Alexion, and Lundbeck were the subject of SOJ lawsuits asserting kickbacks and committing general violations of Medicare laws. The United States Department of Justice has decided to agree to a settlement of $122.6 million in total from these three alleged Medicare violators.

The drug companies were accused of offering remuneration in hopes of encouraging patients to purchase their medications. They would pay kickbacks, a form of negotiated bribery, to patients of Medicare and Civilian Health and Medical Program (ChampVA) under the guise of charitable organizations that subsidized the co-pays. This is not an uncommon practice, but it is one many law enforcement programs are attempting to discontinue.

The DOJ states that in this case, the companies violated the Federal False Claims Act. This act is a way of imposing liability onto anyone, be it a group or individual, that has been discovered interfering with government-funded programs such as in this case with Medicare. This is one of the government’s main tools in defending against fraudulent acts.

The Swiss drug manufacturer Novartis has been accused by the U.S. government of a kickback scheme involving paying doctors millions in kickbacks to promote and prescribe their drugs.The drugs involved in this case including Lotrel and Valturna, which treat hypertension, as well as Starlix for diabetes. The kickbacks to the docs also included what was considered a speaking fee, where doctors would be paid to discuss the drugs at educational events and even within their own office. The doctors were also treated to meals that can be considered lavish at the price point of $9,750 for three dinners at a Japanese restaurant.

Unlike a straightforward bribe, kickbacks involve an action being completed after negotiated bribery in the form of a commission or rebate. It is generally viewed as illegal since it gives many companies an unfair advantage in the industry they work for. The False Claims Act is what pushes liability for such actions onto those who attempt to defraud governmental programs such as health insurance.

The Novartis case started in 2011, when a former sale representative, Oswald Bilotta, filed a whistleblower lawsuit under the federal False Claims Act. This type of action allows individuals who have discovered criminal action or intent to come forward on behalf of the government. When a case such as this is filed, the government does hold the right to get involved whenever they deem necessary. In the case of Novartis, Bilotta made the principal claim in 2011 followed by the U.S. government and state of New York intervening in 2013.

Pharmacy fraudHolly Blakely, a former San Antonio pharmaceutical rep in Texas, plead guilty and confessed her involvement in an $8.8 million healthcare fraud scheme.

Initially, Holly Blakely was charged in a 30-count indictment. This allegedly means that she paid more than $400,000 in bribes and kickbacks to clinicians for prescribing compounded medications. Compound medication is basically personalized medications produced in order to fit an individual’s exact medical needs. In this case, these compound medications, in particular, were designed to ease pain, but the people these were being given to did not require them.

Blakely confessed that she worked with two compounding pharmacies in order to push prescriptions for compound drugs. The pharmacies would then submit claims to health plans such as Tricare. In exchange for her part of the fraud, Blakely was paid $1.15 million.